When you're planning a wedding, there's no shortage of things to worry about: the venue, the caterer, the guest list, the flowers, the dress, the photographer. Somewhere between choosing between chicken and fish, most couples never think to add "health screenings" to their to-do list.
But here's the thing: you're about to commit to sharing your life with another person. You'll share finances, a home, perhaps children. You'll make healthcare decisions for each other. You'll be each other's emergency contact, power of attorney, next of kin. Shouldn't you share some important health information too?
Premarital health testing isn't about distrust or finding reasons not to marry. It's about starting your marriage with open communication, shared knowledge, and the ability to plan together for whatever health challenges may come. Here are seven health screenings every couple should consider before saying "I do."
1. Sexually Transmitted Infection (STI) Panel
Let's address the awkward one first. Many couples feel that asking for STI testing implies distrust or questions about fidelity. But STIs can be contracted long before a current relationship, can remain dormant for years, and can be present without any symptoms. Testing is simply responsible health behavior.
A comprehensive STI panel typically includes testing for:
- HIV: Early detection allows for treatment that can reduce viral load to undetectable levels, protecting both partners.
- Hepatitis B and C: Both can cause serious liver disease and can be transmitted sexually. Hepatitis B is preventable with vaccination.
- Syphilis: Easily treatable when caught early, but can cause serious complications if left untreated.
- Gonorrhea and Chlamydia: Often asymptomatic, especially in women, but can cause fertility problems if untreated.
- Herpes (HSV-1 and HSV-2): Extremely common and often asymptomatic. While not curable, knowing your status allows for informed decisions about transmission prevention.
- HPV: The most common STI, with certain strains linked to cervical and other cancers. Testing and vaccination are available.
Getting tested together can actually strengthen your relationship. It demonstrates honesty, responsibility, and care for each other's wellbeing. If either partner does test positive for something, you can face it together and make informed decisions about treatment and prevention.
2. Blood Type and Rh Factor
Knowing your blood type seems basic, but many people don't know theirs until a medical emergency requires it. For couples planning to have children, Rh factor is particularly important.
The Rh factor is a protein on red blood cells. If you have it, you're Rh positive; if not, you're Rh negative. Problems can arise when an Rh-negative mother carries an Rh-positive baby (inherited from an Rh-positive father). The mother's immune system may produce antibodies against the baby's blood cells, potentially causing serious complications in current or future pregnancies.
This condition, called Rh incompatibility, is highly manageable when known about in advance. An injection of Rh immunoglobulin (RhoGAM) during pregnancy prevents the mother from developing antibodies. But this only works if you know there's a risk - which requires knowing both partners' Rh status before pregnancy occurs.
Blood type information is also valuable for emergency situations. If your spouse ever needs a blood transfusion, knowing their type in advance can speed life-saving treatment.
3. Genetic Carrier Screening
We all carry genetic mutations - most of them harmless. But some mutations can cause serious diseases in children if both parents happen to carry the same one. Genetic carrier screening identifies whether you carry genes for conditions like:
- Cystic fibrosis: Affects the lungs and digestive system. About 1 in 25 people of European descent are carriers.
- Sickle cell disease: Affects red blood cells, causing pain and organ damage. More common in people of African, Mediterranean, Middle Eastern, and Indian descent.
- Tay-Sachs disease: A fatal neurological disorder. More common in Ashkenazi Jewish, French-Canadian, and Cajun populations.
- Thalassemia: Blood disorders more common in Mediterranean, South Asian, and Southeast Asian populations.
- Spinal muscular atrophy: A leading genetic cause of infant death. About 1 in 50 people are carriers.
Being a carrier doesn't mean you have or will develop the disease - it means you carry one copy of a mutated gene. Problems arise when both parents are carriers of the same condition: each pregnancy has a 25% chance of the child having the disease.
Knowing your carrier status before pregnancy allows you to understand your risks and explore options: natural conception with prenatal testing, IVF with preimplantation genetic testing, donor eggs or sperm, adoption, or simply being prepared for potential outcomes.
4. Fertility Assessment
If you're planning to have children, a basic fertility assessment can identify potential challenges before you start trying. Fertility issues affect about 15% of couples, and the causes are split roughly equally between male and female factors.
For women, a fertility assessment might include:
- Hormone testing (FSH, LH, estradiol, AMH) to evaluate ovarian reserve
- Thyroid function tests
- Pelvic ultrasound to check for structural abnormalities
- Discussion of menstrual history and any concerning symptoms
For men, a semen analysis evaluates:
- Sperm count
- Sperm motility (movement)
- Sperm morphology (shape)
- Semen volume and quality
Discovering fertility issues before you're actively trying to conceive gives you time - time to seek treatment, adjust expectations, explore alternatives, or simply prepare emotionally. It's much better to learn about potential challenges when you can calmly research options than after months of disappointing negative tests.
5. Mental Health Screening
Mental health is health. If either partner has a history of depression, anxiety, bipolar disorder, or other mental health conditions, discussing this openly before marriage is essential - not as a confession of weakness, but as sharing important health information with someone who will be your partner in managing it.
A mental health screening might include:
- Discussion of personal and family mental health history
- Screening questionnaires for depression and anxiety
- Assessment of current stress levels and coping mechanisms
- Discussion of any current medications or treatments
Mental health conditions often have genetic components, which is relevant if you're planning children. They can also be triggered or worsened by major life transitions - like, say, getting married. Understanding each other's mental health needs helps you support each other effectively.
Some couples also benefit from pre-marital counseling, which isn't about having problems but about building communication skills, aligning expectations, and addressing potential conflict areas before they become actual conflicts.
6. Chronic Disease Screening
Many serious chronic diseases are more manageable when caught early. A comprehensive health screening before marriage can establish baseline health status and identify any developing conditions. Tests might include:
Cardiovascular health:
- Blood pressure measurement
- Cholesterol panel (total cholesterol, LDL, HDL, triglycerides)
- Fasting blood glucose or HbA1c (for diabetes risk)
Organ function:
- Complete blood count
- Liver function tests
- Kidney function tests
- Thyroid function tests
Cancer screenings appropriate for age and risk factors:
- Pap smear for cervical cancer
- Mammogram if indicated
- Skin check for suspicious moles
Sharing this information isn't about assessing whether someone is "healthy enough" to marry - it's about entering marriage with full knowledge and the ability to support each other's health needs. If one partner has prediabetes, you can work together on lifestyle changes. If someone has a family history of early heart disease, you can both commit to heart-healthy living.
7. Lifestyle and Habit Assessment
Not every important health conversation requires lab work. Before marriage, honest discussions about lifestyle habits can prevent future conflict and health problems:
Substance use: Alcohol consumption, tobacco use, recreational drug use - these habits affect health, finances, and family life. Being honest about your habits and any struggles with substances is essential.
Sleep patterns: Are you a night owl marrying a morning person? Sleep incompatibility can create real strain. Discuss expectations about bedtimes, morning routines, and sleep environment preferences.
Exercise and activity levels: If one partner is a marathon runner and the other hasn't exercised since high school gym class, talk about it. Mismatched activity levels can create tension, but they can also create opportunities to find common ground.
Eating habits: Vegetarian marrying a meat-lover? One partner strict about organic, the other a fast-food enthusiast? Food is central to daily life and family culture. Discuss how you'll navigate differences.
Family health history: What conditions run in your families? This information helps predict your own health risks and your future children's risks. Share what you know, even if it's uncomfortable.
How to Approach These Conversations
For many couples, these topics feel awkward to bring up. Here are some approaches that can help:
Frame it as "us" not "you." Instead of "I want you to get tested," try "Let's both get full health screenings before the wedding." Making it mutual removes any sense of accusation or suspicion.
Connect it to your future together. "I want us to start our marriage knowing everything we need to know to support each other's health" is more inviting than "I need to know about your health problems."
Do it together. Schedule appointments for the same day, share results together, discuss findings as a team.
Remember that knowledge is power. Whatever you learn, you can face it together. Not knowing doesn't make problems go away - it just means you're surprised by them later.
Treat results with compassion. If testing reveals something unexpected - an STI, a genetic condition, a fertility issue - respond with support, not judgment. How you handle unexpected health news together is a preview of how you'll handle the inevitable health challenges of a long marriage.
A Gift to Your Future Selves
Premarital health testing might seem unromantic compared to choosing wedding flowers. But decades from now, you probably won't remember what flowers you had. You will remember building a marriage on honesty, openness, and mutual care.
Taking the time for health screenings before your wedding is a gift to your future selves - the selves who will face health challenges, make difficult decisions, and support each other through whatever comes. Starting that journey with full knowledge and clear communication sets the foundation for a healthier, stronger marriage.